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The Truth About Medical Education: Corrupted Seeds with Far-Reaching Roots

The continuation and progress of the human condition has been founded on the inheritance of knowledge. With each generation, the lessons learnt are passed on as another valuable brick in the pyramid towards the pinnacle of human success. However, just as progress necessitates the study of the phenomenon in question, the educational system itself has become a topic of scrutiny. Having been a student for most of my life and a mentor intermittently (whether as the fearless older sister or a tutor for other students), the architecture of the educational system is something that I have often pondered over. My dual citizenship in two very different cultures has provided me with two strains of the education system — one of Taiwanese, the other American — to juxtapose. No educational system is perfect, and I don’t believe it is possible to create a curriculum that can be “one size fits all.” That being said, as a current medical student, I often talk to past, current, and future medical students and wonder why medical school is so difficult? While the analogy of “drinking from a fire hose” parallels the insane amount of knowledge we must absorb within the given timeline and contributes to the difficulty of medical education, I find it hard to believe that time-pressed content is the sole reason. I believe that the attitudes and expectations already planted in our minds, the curriculum design, and the methods of student evaluation are crucial factors — just to mention a few — that contribute to the hefty weight that we carry as medical students.

This obsession of equating personal worth with quantitative measurements and percentages has been adopted not only by the administrative system but also by our own egos. This behavior has become so ingrained and reinforced that it is almost second nature to most of us. Consequently, this system fosters hostile and even stunting learning environments. With the rise of mental illness and suicides affecting especially physicians, medical schools have over the years strived to reduce these stresses upon medical students. Many institutions have implemented a pass-no pass (P/NP) system to reduce competitive attitudes and remove some of the students’ self-imposed need for grade-gratification. While that has helped to ease the neurotic, competitive mentality of medical students, the numbers of physician suicide and mental illness continue to rise, and I believe this complex issue extends its roots much deeper.

Medicine is a society of tradition. The transition of letter-grade-based curriculum to one that of P/NP has been one of suspicion over the years. While numerous institutions have incorporated some sort of P/NP system, its efficacy and ability to maintain quality of medical students have been debated. For the most part, the elimination of grades has removed much of the competitiveness among classmates and fostered cooperation among fellow classes. Speaking from personal experience, the lack of grade stratification with a modified P/NP system within my own institution has encouraged a lot of support among our classmates. Resources are easily shared, and students don’t feel the need to protect their knowledge from each other. Instead of an individualistic success on exams, students strive to work together in teams and study groups to perform well as a class. Studies have pointed out this system fosters self-motivation and promotes qualities of self-regulated learning without the imposed incentive of grades that are essential in future physicians. Furthermore, literature has shown that implementing a P/NP system improves psychological well-being during pre-clinical years, thus possibly serving as a protective factor against burnout. On the other hand, skeptics point out the possibility of motivation loss, weakened competitiveness, and reduced performance. While a study has shown a decrease in examination performance in preclinical examinations, USMLE scores were not affected. Although fully embracing the P/NP system with ample resources have served as a positive force on medical student performance and wellbeing, there are other factors at play that can be improved.

Personally, I think the Achilles heel of the American educational system is the lack of a real teacher-student relationship. I am sure this is completely relatable to many of us. Complaints of unenthusiastic professors or abrasive residents and physicians are so common that it has become an expected background noise to us. But why have we become accustomed to this lack of engagement from our mentors? Why is that the norm? We certainly deeply appreciate it when professors succinctly deliver complex concepts or when mentors beautifully guide us to better ourselves with grace. Why should that be a happy surprise instead of that being a standard for all of us?

It has become a pet peeve of mine when I hear, “Oh, well, if this doesn’t work out, then I’ll just get a degree and teach.” In this generation, social status and perspectives towards teachers and professors have stooped so low that the profession of a mentor has become a backup plan. Coming from an Asian background (in which I was schooled under the Taiwanese educational system throughout grade school and middle school), this is blasphemy to me. The Confucian-influenced history has shown us that teachers are the nurturers of the future and can serve as profound inspirations to open the box of endless of potential in an individual. So many of my own classmates place one of their most phenomenal influences in their personal and academic lives to be a teacher or professor they once had. That being said, it should be obvious that the amount of hope and efforts we put into our future generation should be equally invested into the teachers that will transmitting those qualities into their students. So why isn’t that the case? Whether in my undergraduate or medical school institution, I have witnessed so many professors go through the motions of teaching, treating each hour of lecture as an obligatory burden that comes with the occupation instead of as an opportunity to inspire and motivate. Students are lectured to as a wooden audience, and we’re often treated as a faceless mass of quietly absorbing sponge. We’re preached to not passively learn and absorb the material, but how can we be expected to actively learn when the material being presented to us is passively taught?

What we need is teachers that care about the topics they are teaching as well as their students’ learning and growth. What we need is an education system that nurtures our academic growth as future physicians instead of dangling the prize of numbers for us to step over each other and fight for as good test takers. What we need is a curriculum in which students actively learn while mentors actively teach. Medical students don’t simply become neurotic over our academic performances with the stresses of medical education; we come in already instilled with the mindset that performing on tests equate to our intellectual prowess. We arrive at medical school believing that the students who sit next to us during lectures or in the libraries are our rivals instead of our colleagues. We believe that being good students naturally means that we will become good physicians. We are tested on how well we study and problem solve, and these scores determine our outcome in residencies.

It is so easy to forget that the true qualities that comprise an excellent physician lies beyond some percentage or some score. I know so many of my fellow classmates that will become incredible physicians who aren’t at the top of the class. And I know so many classmates compromise on things they would really love to do and agonize excessively because they have to “do well” on their exams. We’re all intelligent and capable individuals — we have all jumped through the rings of fire to get into medical school — so what’s the point of further stratifying us into tiers of academic excellence? Despite having molded our curriculum to ease our distresses with implementing a stratified P/NP system, the issue has taken root far before, having also locked its power in the deepest neurons in our subconscious so that by the time we step into the medical school classroom for the first time ever, we’ve already understood that our personal futures and successes rides on the numbers that we can make, and not the lessons we learn from our mentors.

Nita Chen, MD Nita Chen, MD (39 Posts)

Medical Student Editor and in-Training Staff Member Emeritus

University of Florida Fixel Movement and Neurorestoration Institute

Nita Chen is a current movement disorders fellow at University of Florida Movement and Neurorestoration program. She is Class of 2017 medical student at Albany Medical College. To become cultural, she spent her early educational years in Taiwan and thoroughly enjoyed wonderful Taiwanese food and milk tea, thus ruining her appetite for the rest of her life in the United States. Aside from her neuroscience and cognitive science majors during her undergraduate career, she holed herself up in her room writing silly fictional stories, doodling, and playing the piano. Or she could be found spazzing out like a gigantic science nerd in various laboratories. Now she just holes up in her room to study most of the time.